Journal of Isfahan Medical School
Year:2007 | Volume:25 | Issue:84|Papers Count:19

Background: Cigarette smoking and hypertension (HTN), are both major risk factors for premature atherosclerosis. Currently, limited information is available from the effect of these risk factors on the Pattern of vessel involvement and also on the left ventricular ejection fraction (LVEF) at coronary angiography. Our study compared their effects on angiography of patients with premature atherosclerosis.Methods: The study included 240 consecutive patients, under age of 45 years old, cigarette smoker or hypertensive hospitalized with a diagnosis of acute coronary syndrome. These patients underwent coronary angiography. Number and type of vessel involvement and also LVEF were studied. Logistic regression was used for data analysis.Findings: Of patients, 24 were both smoker and hypertensive, and were excluded from this study. In addition, 142 of 216 patients (65.7%) were smoker and 74 (33.4%) were hypertensive. Left anterior descending coronary artery (LAD) involvement was more common in smoker young patient and low LVEF was more common in these patients compared with hypertensive young patients (28.2% versus 17.6%, respectively).Conclusion: Our findings indicate that smoking is more prevalent risk factor for premature coronary artery disease. Smoking has a significant effect on the pattern of vessel involvement and LVEF at coronary angiography of young patients. Our study emphasized on the importance of modifying in young active population.

Background: Iron deficiency anemia (IDA) is a recognized feature of celiac disease in adults and can be its only presentation. The goal of this study was to assess the prevalence of celiac disease in a sample of Iranian patients with IDA referred to gastroenterology clinic.Methods: In this prospective study, 126 consecutive patients with IDA (Hb<14g/dl in male, Hb<12g/dl in female and ferritin <38g/dl) aged 15-71 years referred for endoscopy were included in this study. If endoscopy was normal, at least two distal duodenal biopsies were taken. In addition, antigliadin antibody (AGA) and antiendomisial antibody (AEA) were checked in these patients.Findings: In 8 (6.3%) patients, duodenal biopsies revealed histological features of celiac disease according to revised Marsh criteria (6 patients, Marsh IIIA and 2 IIIC). The average Hb level was 8.8 mg/dl. Six of these patients (75%) had positive serology for celiac disease (2 positive antiendomysial, 3 positive antigliadine and 1 positive for both antibodies). Gluten-free diet was recommended to these eight patients and clinical and hematological response was observed in all of them. After four months the mean hemoglobin concentration of the patients was 13.2g/dl.Conclusion: A considerably high prevalence of celiac disease was documented among patients with IDA of unknown cause. We suggest that distal duodenal biopsy should be taken in patients with idiopathic IDA in order to exclude celiac disease.

Background: Laryngoscope blades are in contact with mucous membrance and can pissiblily contaminated with transmissible microorganisms. The cover for the blade of the laryngoscope may be can prevent the cross infection. The aim of this study was to evaluate the effect of use of disposable nylon sheath over laryngoscope blade on bacterial contamination of harynx and post operative sore throat.Methods: 66 patients undergoing general anesthesia were included in this study. In case group (n=32) a translucid nylon cover enclosing the blade of laryngoscope. In control group (n=34) the blade used without cover. Before induction of anesthesia, in both groups the samples from blade and before induction of anesthesia and 24hr after operation the sample from patient's pharynx were obtained and sent for aerobic and anaerobic bacterial culture. Frequency of positive culture and post operative sore throat were determined. The intensity of post operative sore throat was assessed at 24hr after operation using visual analogue scale (VAS). Data were analyzed using chi-square, Fisher exact, McNemar and t-tests.Findings: The frequency of positive culture of pharynx before induction of anesthesia in case and control groups was 89.3 % and 94.1 % respectively (P>0.05). This frequency was 43.7 % and 61.8 % at 24 hr after operation (P>0.05). In 6 samples of laryngoscope blade, bacterial culture was positive. The occurrence of post operative sore throat in both groups was 62.5% and 52.9% respectively (P>0.05). There were no correlation between pharyngeal cultures and post operative sore throat.Conclusion: The bacteriological study of laryngoscope blades showed that the routine cleaning and sterilization of blades in our hospital is effective. Laryngoscope blade cover has no effects on bacterial contamination of pharynx and post operative sore throat.

Background: The p53 tumor suppressor gene plays an important role in genomic stability. A common G-to-C polymorphism at codon 72 in the p53 gene has been accompanied with high risk of lung, nasopharyngeal, oral, prostate, and colorectal cancers, and may result in genetic susceptibility to breast cancer. We studied the effect of this p53 polymorphism on breast invasive ductal carcinoma developmentMethods: This case–control study was conducted among 51 patients with breast invasive ductal carcinoma and 51 matched controls in Isfahan. P53 codon 72 genotypes were identified using allele-specific polymerase chain reaction (PCR).Findings: In control samples, the genotype distribution of p53 polymorphism showed 43.2%, 52.9% and 3.9% for the Arg/Arg, Arg/Pro and Pro/Pro genotypes, respectively. In cancer group the distribution was 86.2% for Arg/Arg, 11.8% for Arg/Pro and 2% for Pro/Pro. Distribution differences in p53 codon 72 polymorphism between the cases and controls were statistically significant (P<0.001).Conclusion: This study indicates that p53 codon 72 polymorphism is a genetic predisposing factor for breast invasive ductal carcinoma development in samples of Isfahan. However, further studies are needed to determine the role of p53 codon72 polymorphism in breast cancer development.

Background: The objective of this study was to measure the radiation dose absorbed by testes in those men receiving pelvic radiotherapy in order to provide appropriate shielding.Methods: Thermo luminescence dosimeter (TLD) which is in small tablet forms was used for this study. Patients were selected and were advised of the procedure. The TLD tablets were positioned in the appropriate places over the gonads and then the absorbed dose was determined. In this study the correlations between the absorbed dose of the gonads and factors such as the radiotherapy system energy, variation in the source skin distance (SSD) of the instrument, the pelvic area and the radiation direction were determined.Findings: Results showed significant association of the radiotherapy system energy, SSD variation, and pelvic area with the absorbed dose of the gonads (P < 0.05).Conclusion: Our findings show that in pelvic radiotherapy the gonads are exposed to high radiation energy. This is an important issue for young men in order to protect their fertility. Therefore, it is very important to protect the gonads from the ionizing radiation with the best possible shielding.

Background: Homocysteine is a sulfur containing amino acid, and its high concentration is known as cardiovascular risk factor results in oxidative stress and vascular disease. There are some studies on cardiovascular effects of homocysteine but its effect on the reperfusion injury is not completely understood. Hence the effect of homocysteine on the ischemia–reperfusion injury in isolated rat heart has been considered in this studyMethods: In this experiment 32 male wistar rats were used. The hearts of animals were isolated according to Langendorff method and perfused by Kreb’s solution under constant pressure. Experimental protocol in control group was I: Stabilization period and recording of baseline values, II: Normothermic global ischemia (40min), and III: Reperfusion (45 min). In addition to this protocol, homocysteine (0.5 mmol/lit) was added to Kreb’s solution for 30 min before and 5 min after ischemia in test group I. In test group II and III, homocysteine (0.1 & 0.05 mmol/lit) were added to solution for 60 min before and 5 min after ischemia, respectively. Functional cardiac parameters were measured during different periods. Data were analyzed by paired t-test, unpaired t-test and one way ANOVA followed by Tukey post test appropriatelyFindings: The maximum concentration of homocysteine (0.5 mmol/lit) significantly increased coronary flow before ischemia. In addition, rate pressure product (heart rate×left ventricular pressure) as a functional cardiac parameter in test group II (5955±566 beat per minute×mmHg) significantly decreased in comparison to control group (10818±765) after 45 min reperfusion (P<0.05).Conclusion: The findings of this study showed the exaggerated reperfusion injury in the test group with longer perfusion time and moderate concentration of homocysteine; This effect is suggested to be due to exaggerated oxidative stress in reperfusion period.

Background: Leukemia is a kind of malignancy blood system which leads to death of human beings in a very short period of time. In this paper, the effective factors on survival time of the acute lymphoblastic leukemia (ALL) patients have been considered to achieve a linear regression model show the relation between the life-time after diagnosis and some explanatory factors.Methods: In this study, the data of 52 patients died from ALL was used. The designed model contained three variables, hemoglobin, large undifferentiated cell (LUC) and age. According to the data suggesting, a kind of mixture distribution, we considered a mixture model for survival time. Applying the EM-algorithm, we have found the maximum likelihood estimate of mean survival time and the Bayesian estimate of the mean survival time by Monte Carlo Markov Chain method.Findings: Based on the obtained estimating survival function, we can predict the survival time of the patients and decide about their treatment protocol.Conclusion: It is suggested that by conducting larger studies and statistical analysis used in this paper, a correlative can be found between clinical & Para clinical findings and the survival time. This model can be used in often kinds of diseases for determining the prognosis.

Background: Inguinal hernia is a common disease especially in men. Hernias have major complications such as incarceration, bowel obstruction, strangulation and even life-threatening problems. Here, all hernias should be treted by surgical operation. Reparation of hernias has two methods: open hernioplasty and laparoscopic hernioplasty. The purpose of this study was to compare the complications and recurrence of hernias after operation by two methods of laparoscopic hernioplasty and open surgery.Methods: In this clinical trial conducted during one year, 80 patients were operated by two surgeons by two methods of laparoscopic and open surgery. Before the operation, the patient’s data were documented in a questionnaire. Patients were visited by their surgeon 6 weeks and at mean 15±6 months after operation in clinic in order to assess the complications and recurrence after surgery. Data were analyzed by SPSS software ver 14 at P<0.05.Findings: In this study, complications such as neuralgia, hematoma and infection after laparoscopic hernioplasty were significantly lower than in open surgery (5% vs.15%), respectively, (P=0.008). The recurrence occurred in three cases in laparoscopic hernioplasty and in five cases in open hernioplasty (P=0.139).Conclusion: The rate of complications, scar and duration of pain after operation was lower and the duration of return to normal activity was faster in laparoscopic hernioplasty via open hernioplasty; but the rate of recurrence had no significant difference between the two groups. We suggest the use of laparoscopic hernioplasty in treatment of inguinal hernias.

Background: Diabetic patients are at risk to viral hepatitis. It is reported that vaccination with routine doses is not sufficient for diabetic patients especially those with type I, but there is some controversies. The aim of this study was to the assessment and compare of HBs-Ab titer in type II diabetics and controls after vaccination against hepatitis B.Methods: In a semi-experimental study, 91 patients with type II diabetes mellitus and 55 non diabetic healthy individuals matched in age, sex, body mass index and smoking were selected by simple non-random sampling. The positive cases for HBs-Ag, HBs-Ab and HBc-Ab were excluded. Vaccination against hepatitis B was carried in 3 times (0, 1, 6 month) with a dose of 20 mg. Then, 3 and 6 months after the last dose, Hb-A1C and HBs-Ab were tested. HBs-Ab titers were compared between two groups using Mann-Whitney U test and the correlation between HBs-Ab and Hb-A1C in two groups.Findings: Three months after vaccination, both in diabetics and controls, the mean HBs-Ab level was 335.8±275.7 and 420.1±348.4 mIU/ml, and 6 months after vaccination it was 530.7±387.9 and 552.5±410.7 mIU/ml respectively (p>0.05). There was an inverse but non-significant correlation between HB A1C and HBs-Ab in diabetics.Conclusion: The findings of the current study confirm that the routine vaccination is sufficient for patients with type II diabetes.

Background: Skin squamous cell carcinoma (SCC) has high potency for aggression and metastasis; Basal cell carcinoma (BCC) is the most common form of skin cancers. These tumors are highly prevalent in middle-aged and old persons and have a high recurrence risk. Few studies showed the relationship between these tumors and cytomegalovirus (CMV). The objective of this study was to assess the prevalence of CMV infection in these skin cancers.Methods: In this cross-sectional study, 60 paraffin embedded tissues including 30 SCC and 30 BCC blocks with non-involved margins were collected. Then slides were prepared by cytomegalovirus specified immunohistochemical staining. They were compared with positive control case under light microscope.Findings: From 30 SCC cases, 4 cases (13.3%) and 1 margin from non-involved cases were positive for CMV. From 30 BCC cases, 2 cases (6.7%), but no margin, were positive for CMV. There was no statistically significant difference in the prevalence of CMV infection according to histological grade, age, site of lesion or margins.Conclusion: The findings of this study do not support the association of CMV infection with SCC and BCC.

Background: Some needs of patients can be provided by application of antimicrobial fibers in fabrics preparation. The aim of this study was to assess the antimicrobial effect of a particular kind of these fibers.Methods: The antimicrobial fibers were produced by Isfahan Poly Acryl Company. We studied three resistant Staphylococcus aureus strains, one Staphylococcus epidermidis strain and one standard Staphylococcus aureus strain (ATCC6538p=PTCC1112).At first sensitivity of sample strains to the controlling effect of pure antimicrobial agent was proved, and then their MIC was determined with agar dilution method. In the next stage, the effect of antibacterial activity of antibacterial fibers on these strains was studied before and after washing. The effect of antimicrobial pure agent of fibers was compared with the effect of penicillin G as the first selected antibiotic for treatment of Staphylococcus originated infections.Findings: Antimicrobial fibers containing 30%, 60% and 100% antimicrobial agent had significant effects on Staphylococcus strains after 24 hours. In spite of the high MIC of penicillin G on these bacteria (32-64 mg/ml), the antibacterial pure agent of fibers with a MIC about 10-4 ml/ml inhibited the bacteria growth.Conclusion: The results confirmed the antibacterial activity of examined fibers in preventing and controlling nosocomial infections resulted from Staphylococcus sp. We hope that clinical trial in the near future would provide the possibility of using these fibers in clinical experiences.

Background: Many references recommend reconstruction surgical method, for treatment of old posterior crutiate ligament avulsion (PCL), in spite of its adverse side effects, difficult surgical procedure and poor long term results. This study was conducted for the first time designed to determine the results of the treatment of the old PCL avulsion by open reduction and fixation.Methods: We tried to determine the efficacy of old PCL avulsion fixation, during a clinical trial with non-randomized sampling, on 15 patients. All patients had giving way instability, pain while climbing and pain while long walking; and had grade III PDT in physical examination. Data were analyzed by using Chi square test.Findings: The frequency of knee instability before and after operation, in 30 and 90 degree flexion, had significant difference (P<0.001). Giving way, had significant difference before and after operation as well, (P<0.001). The frequency of pain while walking and climbing, also had significant difference (P<0.001).Conclusion: In the 15 patients who underwent PCL fixation, the grade of instability reduced to grade I. As therapeutic value of this method is the same as current renewal methods besides its easier procedure and less side effects, so it is recommended to use it necessarily in old PCL. Further studies with larger sample size and prolonged follow up are recommended.

Background: Finding manual skills for special circumstances would be important both for the urologist and the patient. In this study a simple technique was examined to facilitate the removal of ureteral stent by vaginal examination in some female patients under special condition.Methods: Overall, 32 female patients (37 ureteral stent) underwent Stent Removal by Vaginal (SVR) examination technique. The patient was positioned in lithotomic position and was asked to keep her bladder semi-full. The ureteral stent in the ureteral orifice was touched by the index finger between the anterior vaginal wall and the bladder trigone; then the grasping forceps held by the other hand entered the bladder through the urethra to reach the end of the stent and pull it gently and completely.Findings: The technique was done successfully in stents. No significant side effect was observed after using SRV technique, but gross hematuria was seen in eight patients (23%).Conclusion: S.R.V. technique is a simple and effective procedure that dose not require additional equipments or personnel. Was more useful in elderly women with atrophic vaginitis and without cystocele.

Background: Septoplasty is one of the most common procedures in the domain of otolaryngology; though, few studies have discussed objectively how much successful this procedure is. We intended to use active anterior rhinomanometry to show this and correlation between these objective figures with clinical signs and symptoms.Methods: Overall, 48 patients underwent septoplasty procedure by a single surgeon. Before and one month after surgery, rhinomanometric study (measuring nasal flow and resistance) was done. In those periods, clinical symptoms (nasal obstruction) and signs (nasal impaction seen by rhinoscopy) were recorded by another surgeon, as well.Findings: According to history and physical examination, both nasal obstruction and impaction were improved significantly. Nasal flow and nasal resistance improved totally and in each side as well. There significant correlation between obstruction and nasal flow (r=0.34). In 60.4% of patients, strong correlation was found between patient’s satisfaction and clinical findings, as well as a significant but less strong correlation between satisfaction and rhinomanometric findings.Conclusion: Rhinomanometry is able to objectively evaluate the results of septoplasty procedure, so it is a useful and sometimes necessary tool for clinic and research as well as legal issues.

Background: Brucellosis is an infectious disease due to Gram negative bacteria of genus brucella. Involvement of different systems including gastrointestinal tract, the hepatobilliary and skeletal systems has been frequently reported. Involvement of nervous system is not common, and its incidence has been reported to be 3-25% of the cases of generalized brucellosis. In this study, we report a case of Guillain-barre syndrome as an infrequent presentation of neurobrucellosis.Methods: A 28-year-old man is reported, who was referred because of acute progressive flaccid paraplegia, ataxia and areflexia. Electrophysiological and cerebrospinal fluid study was identical to Guillain- barre syndrome. Anti- brucella antibody (ELISA) in cerebrospinal fluid, and serum Wright and 2ME tests were positive.Findings: The patient underwent plasmaphresis for 7 times with 1.5 lit of plasma per day, but without favorite clinical response. By identification of neurobrucellosis, antimicrobial therapy with Doxycycline, Rifampin and Co-trimoxazole was started. He showed considerable recovery 3 months latter.Conclusion: Brucellosis is considered as a new etiologic agent for Guillain – barre syndrome. In endemic region, neurobrucellosis must be considered in any patient with Guillain- barre syndrome.